Organization
HOLY FAMILY MEDICAL ASSOCIATES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BRENDA L THANEL (ADMINISTRATOR)
(316) 682-9900
Entity
Organization
Contact information
Practice address
144 S HILLSIDE ST, WICHITA, KS 67211-2154
(316) 682-9900
(316) 682-0311
Mailing address
144 S HILLSIDE ST, WICHITA, KS 67211-2154
(316) 682-9900
(316) 682-0311
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
04-27664
KS
363A00000X
Physician Assistant
15-01433
KS
363LF0000X
Family Nurse Practitioner
46056
KS
363LF0000X
Family Nurse Practitioner
46183
KS
363LP0200X
Pediatric Nurse Practitioner
46255
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200716880A
—
KS
Enumeration date
03/11/2011
Last updated
12/01/2014
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